MEDICARE: SENTARA MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1326165929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENTARA MEDICAL GROUP

Provider Business Mailing Address
First Line	:	200 EATON ST
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23669-4000
Country	:	US
Telephone Number	:	757-726-5000
Fax Number	:	757-726-5001

Provider Business Practice Location Address
First Line	:	200 EATON ST
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23669-4000
Country	:	US
Telephone Number	:	757-726-5000
Fax Number	:	757-726-5001

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. CINDY A TAYLOR
Credential	:
Telephone Number	:	757-252-3344

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	09/20/2011

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Directions to “SENTARA MEDICAL GROUP ” Practice Location

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